No one in the country is unaware of the rickety condition of the healthcare sector of Bangladesh. The novel coronavirus (COVID-19) has almost devastated the sector. At the same time, this infectious disease has showed the necessity of reforming the sector as well as building a universal health coverage (UHC) system.
People have been demanding the introduction of a universal insurance system for long. And there is the hype of introducing universal pension scheme. This has been in discussion for the last five years but not more than that. Health ministry sources said those three issues would be addressed sporadically in the next budget. But there would be no substantial directives to bring radical changes.
Universal health coverage
According to World Health Organisation (WHO), universal health coverage, or UHC, is that system where everyone who needs services should get them, not only those who can pay for them. Bangladesh has signed the proposal on UHC, brought at the United Nations General Assembly (UNGA) in 2012. Once again, Bangladesh pledged to the UNGA in September 2019 about introducing the UHC.
According to a publication of the WHO in November 2018, patients of Bangladesh spend most among the South Asian nations for medical care. The Bangladesh government spends 28 per cent while the patients cover the remaining 72 per cent expenses.
Speaking to Prothom Alo, Columbia University professor and the founder of BRAC School of Public Health, Mushtaque Chowdhury said the health sector is in a complete mess. The government’s goodwill is enough to implement the universal health coverage.
He said Sri Lanka, Philippines, Vietnam and Morocco are economically closer to us, but they have already implemented the UHC. When Thailand implemented the UHC in 2002, their national income was like that of the Bangladesh today.
Universal health insurance
The national pay commission of 2015 headed by Mohammad Farashuddin recommended introducing insurance policy for the public servants. The matter came to the fore during the last two conferences of the deputy commissioners. A committee headed by additional secretary of Bank and Financial Institutions Division of finance ministry, Arijit Chowdhury, was also formed in this regard. The committee submitted a report with the help of Life Insurance Corporation but that got stuck somewhere in the line.
In a question and answer session at Jatiya Sangsad on 20 June 2019, prime minister Sheikh Hasina, in response to a question of Jatiya Party MP Rustam Ali, said the Awami League government has been planning to introduce health insurance to ensure people’s health care.
Though the average life expectancy in Bangladesh is now over 72 years, unlike many other countries, health insurance is not mandatory in Bangladesh. Around 40 per cent of the country’s population belong to 25 and 54 years of age. They have the highest capacity and chances to earn. As a result, a well-planned financial safety scheme is necessary to keep them free of anxieties. Concerned people say that is why a universal health insurance is necessary.
Professor Syed Abdul Hamid of economics department at Dhaka University told Prothom Alo that there is no way without making health insurance compulsory. But at first various groups could be covered. It could be thought that Tk 10 would be taken as premium from each mobile user in a month to begin the universal health insurance.
He also said most of the Bangladeshis do not have the capacity to bear medical expenses. Insurance could be a simple solution to medical costs. But the policy could not be taken because of the lack of policymakers’ understanding of it.
Universal pension scheme
Former finance minister Abul Maal Abdul Muhith had been talking about introducing a universal pension scheme since the 2014-15 fiscal. The government in 2017 had taken an initiative to amend the existing Public Servants (Retirement) Act, 1974 as well but could not move ahead. However, the finance division has prepared a concept paper on universal pension scheme. It advised to form an authority to introduce and manage the universal pension scheme. That too got stuck somewhere in the line.
Finance ministry sources said around 700,000-800,000 families of government and a few non-government employees have been receiving pension regularly. Outside of them, around 3.5 million poor people, which is one fourth of the total elderly people, have been getting Tk 500 every month.
Speaking to Prothom Alo, former cabinet division secretary Ali Imam Majumder said, “The universal pension scheme could be started considering the elderly people of the country. We have been hearing about this for the last few years but seeing nothing in reality.”